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目的:评价不同胃肠道重建术式后行经内镜逆行胰胆管造影术(endoscopic retrograde cholangiopancreatography, ERCP)的安全性及有效性。方法:回顾性分析2013年1月—2018年3月在北京友谊医院就诊，既往有胃肠道重建手术史且行ERCP操作的患者临床资料，108例患者共进行141次ERCP操作。根据胃肠道重建手术方式分为毕Ⅰ式胃大部切除术后组(33例次)、毕Ⅱ式胃大部切除术后组(74例次)、胆管空肠Roux-en-Y吻合组(32例次)、Whipple术后组(2例次)，分别记录到达十二指肠乳头/胆肠吻合处的成功率、胆管插管的成功率、临床成功率、ERCP术后并发症的发生率及总操作时间等。采用Logistic回归对胃肠道重建后ERCP术后胰腺炎(post-ERCP pancreatitis, PEP)的发生率增加进行危险因素分析。结果:在141次胃肠道重建术后ERCP操作中，到达十二指肠乳头/胆肠吻合处的成功率为89.4%(126/141)，胆管插管成功率85.7%(108/126)，临床成功率为75.2%(106/141)，操作时间为(38.5±23.5) min。一旦完成胆管插管操作，后续治疗的成功率明显增加，高达98.1%(106/108)。毕Ⅰ式胃大部切除术后组、毕Ⅱ式胃大部切除术后组、Roux-en-Y吻合术后组、Whipple术后组到达十二指肠乳头/胆肠吻合处的成功率分别为100.0% (33/33)、87.8%(65/74)、84.4%(27/32)、1/2，4组间差异有统计学意义(n P＝0.034)，各组操作时间分别为(27.5±16.2) min、(40.6±23.2) min、(43.8±27.5) min和(59.5±12.0) min，差异有统计学意义(n P＝0.011)，而胆管插管的成功率及后续治疗操作的成功率则差异无统计学意义(n P均>0.05)。ERCP并发症总发生率为14.2%(20/141)，其中PEP发生率为12.7%(18/141)、出血发生率为1.4%(2/141)。操作时间>30 min (n P＝0.024，n OR＝0.356，95%n CI：0.152～1.278)为胃肠道重建术后PEP发生的独立危险因素。n 结论:胃肠道重建术后患者行ERCP操作是安全可行的，但在技术上极具挑战性。内镜医师应做好充分术前准备，选择最佳诊疗方案，降低并发症的发生率，使患者受益最大化。“,”Objective:To evaluate the safety and efficacy of endoscopic retrograde cholangiopancreatography (ERCP) for patients with altered gastrointestinal anatomy.Methods:Data of 108 patients who received 141 ERCP procedures were reviewed in this retrospective study from January 2013 to March 2018 in Beijing Friendship Hospital, and all patients had a history of gastrointestinal reconstruction. The patients were divided into the Billroth Ⅰ anastomosis group(n=33), the Billroth Ⅱ anastomosis group(n=74), the Roux-en-Y anastomosis group(n=32) and the Whipple group(n=2) according to the type of gastrointestinal anatomy. The success rate of reaching the papilla of Vater (POV)/anastomosis, deep biliary cannulation rate, clinical success rate, incidence of procedure-related complications and the total operation time were analyzed.Results:In 141 ERCP procedures after gastrointestinal reconstruction, the rate of reaching POV/anastomosis was 89.4% (126/141), and deep biliary cannulation rate was 85.7% (108/126). The clinical success rate was 75.2% (106/141) and the mean operation time was 38.5±23.5 minutes. Once the biliary cannulation was completed, the success rate of follow-up treatments significantly increased, reaching 98.1% (106/108). The success rates of reaching POV/anastomosis in the Billroth Ⅰ anastomosis group, the Billroth Ⅱ anastomosis group, the Roux-en-Y anastomosis group and the Whipple group were 100.0% (33/33), 87.8% (65/74), 84.4%(27/32) and 1/2, respectively, with significant difference (n P=0.034). The operation times in these groups were 27.5±16.2 min, 40.6±23.2 min, 43.8±27.5 min and 59.5±12.0 min, respectively, with significant difference (n P=0.011). There was no significant difference in the success rate of biliary cannulation or that of subsequent treatment operations(both n P>0.05). The overall incidence of ERCP complications was 14.2% (20/141). The incidences of post-ERCP pancreatitis (PEP) and bleeding were 12.7% (18/141) and 1.4% (2/141), respectively. Operation time >30 minutes (n P=0.024, n OR=0.356, 95%n CI: 0.152-1.278) was an independent risk factor of PEP after gastrointestinal reconstruction.n Conclusion:ERCP is safe and feasible in patients with gastrointestinal reconstruction. Endoscopists should choose the best therapy to reduce incidence of adverse events in ERCP procedures.